Rhodes Deborah J, Hruska Carrie B, Conners Amy Lynn, Tortorelli Cindy L, Maxwell Robert W, Jones Katie N, Toledano Alicia Y, O'Connor Michael K
1 Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55955.
AJR Am J Roentgenol. 2015 Feb;204(2):241-51. doi: 10.2214/AJR.14.13357.
OBJECTIVE. The purpose of this study was to assess the diagnostic performance of supplemental screening molecular breast imaging (MBI) in women with mammographically dense breasts after system modifications to permit radiation dose reduction. SUBJECTS AND METHODS. A total of 1651 asymptomatic women with mammographically dense breasts on prior mammography underwent screening mammography and adjunct MBI performed with 300-MBq (99m)Tc-sestamibi and a direct-conversion (cadmium zinc telluride) gamma camera, both interpreted independently. The cancer detection rate, sensitivity, specificity, and positive predictive value of biopsies performed (PPV3) were determined. RESULTS. In 1585 participants with a complete reference standard, 21 were diagnosed with cancer: two detected by mammography only, 14 by MBI only, three by both modalities, and two by neither. Of 14 participants with cancers detected only by MBI, 11 had invasive disease (median size, 0.9 cm; range, 0.5-4.1 cm). Nine of 11 (82%) were node negative, and two had bilateral cancers. With the addition of MBI to mammography, the overall cancer detection rate (per 1000 screened) increased from 3.2 to 12.0 (p < 0.001) (supplemental yield 8.8). The invasive cancer detection rate increased from 1.9 to 8.8 (p < 0.001) (supplemental yield 6.9), a relative increase of 363%, while the change in DCIS detection was not statistically significant (from 1.3 to 3.2, p =0.250). For mammography alone, sensitivity was 24%; specificity, 89%; and PPV3, 25%. For the combination, sensitivity was 91% (p < 0.001); specificity, 83% (p < 0.001); and PPV3, 28% (p = 0.70). The recall rate increased from 11.0% with mammography alone to 17.6% (p < 0.001) for the combination; the biopsy rate increased from 1.3% for mammography alone to 4.2% (p < 0.001). CONCLUSION. When added to screening mammography, MBI performed using a radiopharmaceutical activity acceptable for screening (effective dose 2.4 mSv) yielded a supplemental cancer detection rate of 8.8 per 1000 women with mammographically dense breasts.
目的。本研究的目的是评估在对系统进行改进以降低辐射剂量后，补充筛查分子乳腺成像（MBI）对乳腺钼靶检查显示乳腺致密的女性的诊断性能。
对象与方法。共有1651名在之前的乳腺钼靶检查中显示乳腺致密的无症状女性接受了乳腺钼靶筛查，并采用300MBq（99m）锝- sestamibi和直接转换（碲化镉锌）伽马相机进行辅助MBI检查，二者均独立解读。确定了癌症检出率、敏感性、特异性以及活检的阳性预测值（PPV3）。
结果。在1585名有完整参考标准的参与者中，21人被诊断患有癌症：2人仅通过乳腺钼靶检查检出，14人仅通过MBI检查检出，3人通过两种检查方式均检出，2人两种检查方式均未检出。在仅通过MBI检查检出癌症的14名参与者中，11人患有浸润性疾病（中位大小，0.9厘米；范围，0.5 - 4.1厘米）。11人中有9人（82%）无淋巴结转移，2人患有双侧癌症。在乳腺钼靶检查中加入MBI后，总体癌症检出率（每1000名接受筛查者）从3.2提高到12.0（p < 0.001）（补充检出率8.8）。浸润性癌症检出率从1.9提高到8.8（p < 0.001）（补充检出率6.9），相对提高了363%，而导管原位癌（DCIS）检出率的变化无统计学意义（从1.3提高到3.2，p = 0.250）。仅乳腺钼靶检查时，敏感性为24%；特异性为89%；PPV3为25%。联合检查时，敏感性为91%（p < 0.001）；特异性为83%（p < 0.001）；PPV3为28%（p = 0.70）。召回率从仅乳腺钼靶检查时的11.0%提高到联合检查时的17.6%（p < 0.001）；活检率从仅乳腺钼靶检查时的1.3%提高到4.2%（p < 0.001）。
结论。当在乳腺钼靶筛查中加入MBI时，使用适合筛查的放射性药物活度（有效剂量2.4 mSv）进行检查，每1000名乳腺钼靶检查显示乳腺致密的女性的补充癌症检出率为8.8。
